Endocrinology Flashcards
(31 cards)
The American Diabetes Association (ADA) recommends initiation of insulin therapy for treatment for persistent hyperglycemia starting at a threshold of…
180 mg/dL (10.0 mmol/L)
After insulin therapy is started, a target glucose range of ___________ is recommended for most critically ill and non-critically ill patients
140 to 180 mg/dL (7.8-10.0 mmol/L)
At least two first-line tests of which three tests must be abnormal to confirm the diagnosis of cushing syndrome
- overnight low-dose dexamethasone suppression test,
- 24-hour urine free cortisol measurement, and
- late-night salivary cortisol measurement
After confirmation of Cushing syndrome, subsequent steps are to…
(1) determine if the Cushing syndrome is ACTH independent or dependent, and
(2) localize the source of ACTH in ACTH-dependent disease or confirm the presence of adrenal mass (or masses) in ACTH-independent disease
BMD testing within (1)_________ of starting long-term glucocorticoid therapy in adults 40 years and older and in adults younger than 40 years with (2)______
- 6 months
- risk factors for osteoporosis or a history of fragility fractures
teprotumumab, monoclonal antibody to insulin-like growth factor 1 receptor, is an indication for….
moderate-to-severe Graves ophthalmopathy and is typically used in patients unresponsive to or intolerant of glucocorticoids.
patients with type 2 amiodarone-induced thyrotoxicosis and in patients with symptomatic thyroid tenderness from thyroiditis: choice of med …..
prednisone
TSH level will normalize in more than 25% of patients with subclinical hyperthyroidism after _______ weeks
6
asymptomatic subclinical hyperthyroidism caused by a multinodular goiter diagnosis….
suppressed thyroid-stimulating hormone (TSH) level, with normal free thyroxine (T4) and total triiodothyronine (T3) levels with a thyroid scan showing focal uptake of radioactive iodine
When to treat subclinical hyperthyroidism:
- serum TSH levels less than 0.1 μU/mL (0.1 mU/L) and with symptoms,
- cardiac risk factors, heart disease, or osteoporosis,
- postmenopausal women not taking estrogen therapy or bisphosphonates.
Choice of drug for subclinical hyperthyroidism:
Methimazole, once-daily, for short-term use to normalize thyroid function before starting iodine 131 (131I) therapy or thyroidectomy.
Rotterdam criteria for PCOS diagnosis in premenopausal women. Fulfilling two of the following three criteria:
oligo- and/or anovulation; clinical and/or biochemical signs of hyperandrogenism; and polycystic ovaries visualized on ultrasound
In addition to evidence of bone disease, indications for parathyroidectomy in patients with primary hyperparathyroidism include:
- age younger than 50 years.
- serum calcium 1 mg/dL (0.3 mmol/L) or greater above upper limit of normal.
- creatinine clearance less than 60 mL/min.
- 24-hour urine calcium greater than 400 mg/dL (100 mmol/L); or nephrolithiasis or increased risk for kidney stones
In patients with primary hyperparathyroidism, bone-related indications for parathyroidectomy include:
fragility fractures, vertebral fractures, and a dual-energy x-ray absorptiometry T-score of less than -2.5 or less at lumbar spine, total hip, femoral neck, or distal one-third radius.
When is parathyroid sestamibi scan or neck ultrasonography indicated in hyperparathyroidism:
for preoperative adenoma localization if surgery is indicated.
Management strategy for hyperparathyroidism patients with no indication of parathyroidectomy:
periodic reassessment that includes repeat serum calcium and creatinine measurement every 6 to 12 months and BMD measurement of the lumbar spine, hip, and distal radius every 2 years.
management of patients with FHA who have not had resumption of menses after 6 to 12 months of behavioral changes
hormone replacement with low-dose estrogen and cyclic progesterone
Screening recommendation for diabetes
ADA recommends screening for type 2 diabetes in adults aged 35 years or older and considering screening in adults of any age with a BMI of 25 or greater (or ≥23 in Asian Americans) who have one or more additional risk factors for diabetes.
Risk factors for diabetes
first-degree relative with diabetes, high-risk race or ethnicity (e.g., African American, Latino, Native American, Asian American, Pacific Islander), history of cardiovascular disease, physical inactivity, hypertension (≥130/80 mm Hg or taking antihypertensive therapy), HDL cholesterol level less than 35 mg/dL (0.90 mmol/L), triglyceride level greater than 250 mg/dL (2.82 mmol/L), polycystic ovary syndrome, or other conditions associated with insulin resistance.
When is abdominal CT indicated in suspected adrenal tumor
serum DHEAS value is greater than 700 μg/dL (19.0 μmol/L)
When is Pelvic ultrasonography recommended as the first imaging study?
if testosterone is greater than 150 ng/dL (5.2 nmol/L), which indicates that an ovarian source of hyperandrogenism is likely
management of metformin-related vitamin B12 deficiency
Treatment is oral or parenteral vitamin B12 replacement; metformin may be continued
How often vitamin B12 levels should be checked in patients receiving long-term metformin therapy.
annually
Vitamin B6 (pyridoxine) deficiency presentation
nonspecific stomatitis, glossitis, cheilosis, confusion, and bilateral distal limb numbness and burning paresthesia.
